It is estimated
that the cost
associated with
diagnosis and
treatment of
OSA in the US
alone was around
~4.7 billion
dollars in 2015.

that only 50-60% of these patients will fully respond to OAT and in the other 40% the OSA
will remain uncontrolled. This adds cost to the
system both indirect associated with untreated disease and direct, associated with inefficient clinical models (e.g. the cost of OAT in a
non-responder). It is estimated that the cost associated with diagnosis and treatment of OSA
in the US alone was around ~4.7 billion dollars
in 2015. Keeping that cost in mind, it would
be easy to see how any small inefficiencies in
the model could result in hundreds of millions
of wasted dollars. According to a report published by Harvard School of Medicine, assuming 100% treatment effectiveness, increasing
diagnosis would drive economic benefits. Even
with 100% diagnosis, compliance will remain
a critical limiting factor and insurers will likely
demand higher compliance as the treated population grows, and perhaps push more towards
“Precision Medicine” to improve efficiencies.

So, how can we move Dental Sleep
Medicine in the same direction?

Per the Frost and Sullivan Report, the US
market will grow from 180,000-200,000 patients fitted with a custom made oral appliance
in 2013 to over 1,000,000 patients in 2023.
Although this may sound very promising and
a step in the right direction, it does not necessarily associate with better utilization of OAT
as an alternative treatment for OSA patients.
As seen in the figure below, the percentage of
patients utilizing OAT will remain quite low at
~12% by 2020.

The Price of a Good Night’s Sleep: Insights into the US Oral Appliance Market
Tara Shelton, Research Analyst, Frost and Sullivan 2015

16 DSP | Spring 2017

As well, we must consider the cost associated with the OAT non-responders in this small
group. According to the AASM in 2016, the cost
associated with undiagnosed/untreated OSA is
around $6336 per patient. Using this number
and the direct cost associated with OAT (Average: $2,000) and the estimated 1,000,000 patients treated with OAT, the total cost associated
with OAT non-responders is easily estimated.
Although the anecdotal clinical non-responder rate differs from one practitioner to another
(e.g. depending on the level of expertise, tools
and technologies utilized, treatment philosophy,…), I decided to use a conservative 20%
non-responder rate. This will result in 200,000
ineffective OAT per year, which will in turn result in ~1.7 billion dollars per year of wasted
money in Dental Sleep Medicine (200,000 x
(Cost of untreated disease: $6336.00 + Cost of
OAT: $2000). That is in fact the cost associated
with a “trial & error” method as opposed to a
precision medicine model.
On a smaller scale and focusing on individual patients and dental sleep practices, some
of the direct and indirect costs associated with
treatment of OAT non-responders could be:
Cost to the patient:
• Monetary cost associated with the therapy
• Cost of reparative therapy if OAT was
abandoned due to physical complications
• Adverse health consequences associated with untreated OSA
• Potential loss of confidence in the system and alternative therapies
Cost to the Dentist:
• Cost associated with the lost chairtime
(It is commonly believed that OAT
non-responders require an average 4-6
additional appointments compared to
OAT responders, due to difficulties/
challenges associated with their treatment process)
• Indirect cost associated with patients’
loss of confidence in the dentist and
perhaps leaving the clinic
• Indirect cost associated with the referring healthcare professionals’ loss of
confidence in OAT and the dentist, reducing referrals for OAT.
• Indirect cost of loss of confidence within the dental team, reducing screening
activities and growth of SDB treatments
by the dental practice.
Aside from the health economics of Dental
Sleep Medicine, there are many other chal-